Survival Effect of Nephroureterectomy in Metastatic Upper Urinary Tract Urothelial Carcinoma

Sebastiano Nazzani, Felix Preisser, Elio Mazzone, Michele Marchioni, Marco Bandini, Zhe Tian, Francesco A. Mistretta, Shahrokh F. Shariat, Denis Soulières, Fred Saad, Emanuele Montanari, Stefano Luzzago, Alberto Briganti, Luca Carmignani, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Background: Few data examined the potential survival benefit of nephroureterectomy (NU) in the setting of metastatic upper urinary tract urothelial carcinoma (mUTUC). We hypothesized that a survival benefit might be associated with the use of NU in that setting and tested this hypothesis within a large population-based cohort. Patients and Methods: Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1174 patients with mUTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs), relying on inverse probability after treatment weighting and landmark analyses, were used to test the effect of NU versus no surgical treatment on cancer-specific mortality (CSM) in patients with mUTUC. Results: Of 1174 patients with mUTUC, 449 (38%) underwent NU. The rate of NU decreased over time from 47.1% to 34.6% (estimated annual percentage change, −4%; P =.006]. In MCRMs, NU achieved independent predictor status for lower CSM (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.46-0.66; P <.001). In MCRMs stratified according to chemotherapy, NU also achieved independent predictor status for lower CSM, both in patients who received (n = 597; 50.9%) (HR, 0.68; 95% CI, 0.53-0.87; P =.002) or did not receive (n = 574; 49%) (HR, 0.44; 95% CI, 0.33-0.58; P <.001) chemotherapy. Virtually the same results were recorded after inverse probability after treatment weighting adjustment, as well as in landmark analyses. Conclusions: Our analyses suggest a potential survival benefit after NU in the setting of mUTUC, regardless of chemotherapy administration.

Original languageEnglish
Pages (from-to)e602-e611
JournalClinical Genitourinary Cancer
Volume17
Issue number3
DOIs
Publication statusPublished - Jan 1 2019

Keywords

  • Chemotherapy
  • SEER
  • Upper tract
  • Urothelial carcinoma
  • UTUC

ASJC Scopus subject areas

  • Oncology
  • Urology

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    Nazzani, S., Preisser, F., Mazzone, E., Marchioni, M., Bandini, M., Tian, Z., Mistretta, F. A., Shariat, S. F., Soulières, D., Saad, F., Montanari, E., Luzzago, S., Briganti, A., Carmignani, L., & Karakiewicz, P. I. (2019). Survival Effect of Nephroureterectomy in Metastatic Upper Urinary Tract Urothelial Carcinoma. Clinical Genitourinary Cancer, 17(3), e602-e611. https://doi.org/10.1016/j.clgc.2019.03.003